Provider Demographics
NPI:1588080535
Name:AWAHMUKALAH, DIVINE PROWO (PCA)
Entity type:Individual
Prefix:
First Name:DIVINE
Middle Name:PROWO
Last Name:AWAHMUKALAH
Suffix:
Gender:M
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5819 CHERRYWOOD LN APT 301
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-4225
Mailing Address - Country:US
Mailing Address - Phone:302-898-6638
Mailing Address - Fax:
Practice Address - Street 1:1420 K SREET 7TH FLOOR
Practice Address - Street 2:ASAP SERVICES CORPORATION
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-293-2931
Practice Address - Fax:202-293-3480
Is Sole Proprietor?:No
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide